Requiring doctors to have hospital admitting privileges does more harm than good for women. Ideology drives the false claim that it protects them.

As the Supreme Court's Jan. 22 Roe v. Wade decision turns 46 years old, state legislators across the country are planning more anti-abortion laws. Although supporters of these restrictions may claim that they are medically prudent, designed to protect patient health, the reality is they have no scientific basis.

One of the many types of abortion restrictions spreading across the country is a requirement that abortion providers have admitting privileges at a local hospital or that clinics have transfer agreements with a local hospital. Due to administrative barriers or anti-abortion sentiment, abortion facilities and clinicians often can’t get these admitting privileges. That leads to clinic closures, forcing women to leave the state to obtain an abortion and creating abortion deserts.

Last October, Missouri’s admitting privileges law went into effect, and as a result, Missouri is now one of six states in the country to have only one abortion facility. As a professor of public health and an expert in the safety of abortion, I know from my latest research that admitting privileges laws simply are not supported by evidence.

Currently two other states, North Dakota and Utah, have admitting privileges laws in effect, and eight states require abortion facilities to have formal transfer agreements with a local hospital. Anti-abortion advocates hope that legal challenges to the Missouri law and a similar one in Louisiana will find their way to the Supreme Court. Although both of these states’ admitting privileges laws are nearly identical to the one in Texas that was found unconstitutional in 2016, the new conservative majority on the court may produce a different result this time.

Advocates of these laws usually use the misconception that abortion is unsafe to make arguments in favor of admitting privileges requirements and other abortion restrictions. In reality, less than one-third of 1 percent of abortions result in a major complication. Abortion is safer than wisdom tooth extraction and tonsillectomy, so it’s clear that these laws aren’t actually about protecting patients. Indeed, my research shows these policies have no observable effects on patient safety.

My colleagues and I in the Department of Obstetrics, Gynecology and Reproductive Sciences at University of California, San Francisco wanted to better understand the impact of admitting privileges laws; specifically we wanted to know if patients who do require care at a hospital related to an abortion receive different or better care when their abortion provider has admitting privileges.

Admitting privilege laws don't protect women

What we found was surprising; few of the patients we studied actually had abortion complications. Most were transferred or referred to a hospital because the abortion-providing clinician suspected the patient had an ectopic pregnancy (a pregnancy in the Fallopian tubes or elsewhere outside the uterus) or because the patient was high risk and they thought the abortion would be safer done in a hospital.

We also found many cases of hospital referrals or self-referrals that occurred after the patient went home, usually either because the patient’s lab results suggested she may have an ectopic pregnancy or because she was concerned about her symptoms after her abortion. In all of these cases, the patients went to a hospital closest to their home, not closest to the abortion clinician with admitting privileges. One patient we came across lived 160 miles from the abortion facility (and the hospital where the provider had admitting privileges).

In cases of emergency transfers, we observed no difference in care before and after providers attained admitting privileges. Among all 46 cases, four patients were transferred immediately to a hospital. Two occurred before and two occurred after clinicians had admitting privileges. In all cases, an ambulance was called, and facility staff and/or the physician coordinated with the hospital by phone regardless of whether they had privileges.

Courts must weigh harm to women

In cases of emergency transfers, we observed no difference in care before and after providers attained admitting privileges. Among all 46 cases, four patients were transferred immediately to a hospital. Two occurred before and two occurred after clinicians had admitting privileges. In all cases, an ambulance was called, and facility staff and/or the physician coordinated with the hospital by phone regardless of whether they had privileges.

Even where abortion-providing clinicians had admitting privileges, the hospital-based physician conducted the initial assessment and admitted patients to the hospital. Our findings suggest that most of the times when patients obtain abortion-related hospital-based care, the admitting privileges of the abortion care provider or the presence of a transfer agreement law have no bearing on patient outcomes.

When clinicians can’t obtain admitting privileges, facilities are forced to close and women have to travel further to obtain care. That causes further delays in obtaining an abortion, which is associated with higher clinical risks and compounds emotional and financial burdens. The end result is that women often aren’t able to get the abortion they want, and autonomy over their life course is taken away.

The assertion that admitting privileges laws protect patients is yet another false argument advanced by those who seek abortion laws based on ideology, rather than scientific evidence. State legislatures have an obligation to ensure that claims made by proponents of laws are backed by evidence before they vote for them. And courts have a legal and ethical responsibility to weigh the benefits of these laws against the harm they cause to patients.

Ushma Upadhyay is an associate professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco and Director of Research at the UC Global Health Institute's Center of Expertise on Women's Health, Gender, and Empowerment. Follow her on Twitter: @UshmaU

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